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. 2016 Jul 14:6:400.
doi: 10.7916/D87944SS. eCollection 2016.

Bilateral Hypertrophic Olivary Degeneration and Holmes Tremor without Palatal Tremor: An Unusual Association

Carlos Cosentino  1 , Miriam Velez  1 , Yesenia Nuñez  1 , Henry Palomino  1 , Darko Quispe  1 , Martha Flores  1 , Luis Torres  1
Affiliations

Bilateral Hypertrophic Olivary Degeneration and Holmes Tremor without Palatal Tremor: An Unusual Association

Carlos Cosentino et al. Tremor Other Hyperkinet Mov (N Y). .

Abstract

Background: Lesions in the Guillain-Mollaret triangle or dentate-rubro-olivary pathway may lead to hypertrophic olivary degeneration (HOD), a secondary trans-synaptic degeneration of the inferior olivary nucleus. HOD is usually associated with palatal tremor and rarely with Holmes tremor. Bilateral HOD is a very unusual condition and very few cases are reported.

Case report: We report here two cases of bilateral HOD after two different vascular lesions located at the decussation of superior cerebellar peduncles, thus impairing both central tegmental tracts and interrupting bilaterally the dentate-rubral-olivary pathway. Interestingly, both developed bilateral Holmes tremor but not palatal tremor.

Discussion: Lesions in some of the components in the Guillain-Mollaret triangle may develop Holmes tremor with HOD and without palatal tremor. Magnetic resonance imaging is an invaluable tool in these cases. Better understanding of the pathways in this loop is needed.

Keywords: Guillain–Mollaret triangle; Holmes tremor; olivary nucleus.

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Conflict of interest statement

Funding: None.

Conflict of Interest: The authors report no conflict of interest.

Ethics Statement: This study was considered exempted from review by the Institutional Ethics Committee.

Figures

Figure 1
Figure 1. (a,b) Midbrain hemorrhage and bilateral hypertrophic olivary degeneration.
Figure 2
Figure 2. (a,b) Midbrain ischemia and bilateral hypertrophic olivary degeneration.
Figure 3
Figure 3. Guillain–Mollaret Triangle. (a) Dentate-rubral tract; (b). Dentate-rubral-olivary tract; (c) olivo-dentate tract.
See this image and copyright information in PMC

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